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Curriculum Overview



This curriculum consists of 6 tasks designed to teach advanced open knot-tying and suturing skills that include fine suture and needle handling within space-constrained and at-depth conditions.  While knot-tying and suturing are applicable to other techniques, such as laparoscopic and robotic surgery, this curriculum focuses solely on open techniques.

Target Learners 

This curriculum is intended for individuals who have already mastered basic knot-tying and suturing.  It is suitable for residents, fellows, and junior faculty in surgical fields. 

Tasks Covered

The ATOSS curriculum consists of the following tasks:

  • Task 1: Suture tying without needle, at depth
  • Task 2: Suture tying with needle, at depth
  • Task 3: Suturing, pitch and catch, superficial
  • Task 4: Suturing, push-push-pull, superficial
  • Task 5: Suturing, pitch and catch, at depth
  • Task 6: Suturing, push-push-pull, at depth

The ATOSS task set includes a 3D-printed iliac fossa model, supplies, and fine instruments. This website provides a curriculum guide with detailed instructions for set up, steps, and scoring for each task. It also provides instructional and example videos.

Relevant Literature

  1. Greenberg AL, Karimzada MM, Brian R, Yap A, Luu HY, Ahmed S, Huang C-Y, Waits SA, Hirose R, Alseidi A, Rapp JH, O’Sullivan PS, Chern H, Syed SM. Assessment of Surgeon Performance of Advanced Open Surgical Skills Using a Microskills-based Novel Curriculum. JAMA Netw Open. 5, e2229787 (2022).
  2. Claflin J, Waits SA. Three dimensionally printed interactive training model for kidney transplantation. J Surg Educ. 2020;77(5):1013-1017.
  3. Bingmer, K., Ofshteyn, A., Stein, S. L., Marks, J. M. & Steinhagen, E. Decline of open surgical experience for general surgery residents. Surg Endosc 34, 967–972 (2020).
  4. Bashankaev, B., Baido, S. & Wexner, S. D. Review of available methods of simulation training to facilitate surgical education. Surg Endosc 25, 28–35 (2011).
  5. Alkhoury, F., Martin, J. T., Contessa, J., Zuckerman, R. & Nadzam, G. The Impact of Laparoscopy on the Volume of Open Cases in General Surgery Training. J Surg Educ 67, 316–319 (2010).
  6. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004 Oct;79(10 Suppl):S70-81.
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